NDIS funding focus and rushed rollout could be undermining outcomes

By Stephen Easton

Monday May 15, 2017

There is rising concern that the National Disability Insurance Scheme rollout is being compromised by the overarching political focus on keeping the national reform on time and on budget.

For politicians, keeping the cost to taxpayers to the original estimates and sticking to the schedule are understandably major issues.

But people with disabilities, carers and service providers have very high expectations of the outcomes the NDIS will achieve. And the extent to which the NDIS can live up to them, in terms of the quality of support plans as well as consistency and fairness in the process, is increasingly being questioned.

A range of concerns and questions have emerged throughout the rollout, many of which broadly involve overall financial sustainability or delivery deadlines placing limitations on the support that people with disabilities can receive.

The Australian National Audit Office has explored some key risks and the Productivity Commission, which designed the scheme, is now going back over the costs. The National Disability Insurance Agency — a much smaller entity with a much smaller role than what the PC originally proposed — now has a more commercially focused board with a bunch of pre-existing governance challenges.

Western Australia has gone its own way with a unique version of the NDIS, against the strenuous opposition of former NDIA chair Bruce Bonyhady, and the federal minister to a lesser extent, who both criticised a flimsy evaluation report published to justify the decision. On the other hand, some observers say elements of the WA model make it closer to the original idea of the NDIS.

Meanwhile, “reasonable and necessary” support is open to wide interpretation — with the result that what can and can’t be funded varies considerably from person to person, and disputes like Liam McGarrigle’s have already gone to court.

A level of inconsistency is to be expected from a system that is tailored instead of one-size-fits-all, but sources in the disability support sector are worried the process is being rushed and is not personalised enough, especially for those with higher care needs, who require assistance to be able to have as much input as possible.

There’s so much going on it can be overwhelming, confusing and alarming. But can such a big reform take place any other way?

Public service researcher Helen Dickinson considered the rising tide of critical perspectives for The Conversation in April and argued challenges are to be expected with such a large, complex reform, especially one being implemented at “break-neck speed”.

“But having patience doesn’t mean ignoring these problems either,” the University of New South Wales associate professor cautions. “The government needs to ensure appropriate mechanisms are put in place to learn from issues as they arise.”

Break-neck speed

National Disability Services, a peak body for service providers, argues “the haste in processing new entrants is affecting the quality of their plans” in a recent report with 24 detailed recommendations to get the NDIS on track.

NDS is far from alone in holding serious concerns about the quality of the support planning process, which is crucial to outcomes for individual participants. Plenty of other observers also blame the rapid rollout, which involves planning done quickly over the phone by a consulting firm, even for high-needs clients in some cases.

It’s clear from conversations with several experts, surveys and observations of online NDIS forums that there is lots of inconsistency and confusion. Participants who couldn’t be happier are easy to find, but so are those who feel there is far less “choice and control” than was promised, and that they must fight hard to get what they need.

The service provider peak body essentially argues its members should have a bigger role in the support planning process and wants restrictions designed to avoid conflicts of interest relaxed, arguing they can be managed. But beyond its narrower perspectives, NDS also tries to turn the focus from funding to quality. For example, it comments:

“During the trial phase of the NDIS, participants were invited to comment on their draft plan before it was finalised. That practice has largely ceased. The consequence is that participants can end up with a plan that doesn’t reflect their needs and goals. Some participants receive plans they don’t recognise. Consistent with the NDIS’s focus on choice and control, participants should always have the opportunity to comment on their plan before it is finalised.”

NDS judges the quality of support plans as highly inconsistent, ranging from “excellent” to “poor” — and notes the poor ones take “substantial effort by participants, their families and providers to rectify”.

Along with speed, the provider peak body lists federal funding arrangements and political battles over the budget as a principal source of pressure on the scheme.

NDS notes that ensuring “affordability” is a big concern for the NDIA and a big political debate for federal politicians:

“Finding savings … amidst the many claims on the Federal Budget, is an ongoing and difficult task.”

This year’s federal Budget contains funding for the scheme once again. And once again the NDIS is at the centre of the political debate over where the government should find revenue and savings. The scheme is Treasurer Scott Morrison’s chief example of a nice thing we can’t have if the Senate doesn’t agree to his specific plans.

The opposition is still fighting off claims the scheme was not fully funded in the 2013 budget, over three years since it lost power. The government is still telling the public the NDIS is not yet funded, and will not be unless the Senate agrees with its taxation proposals.

The NDS report also lists the NDIA’s need for robust back-end systems that can work at scale as another pressure point, along with the clear and present danger of widespread market failure as the agency rushes to expand the scheme.

Dickinson points out that in the United Kingdom, efforts to create a market for disability services and introduce consumer-directed payments occurred over several decades, and still faced big implementation challenges.

Some NDIS watchers believe the strong focus on cost and delivery timeframes at federal level is harming the quality of outcomes for individuals, which increasingly appear as a second-order issue when the NDIS is discussed.

Satisfaction mixed so far

The Every Australian Counts campaign, which lobbied for the Productivity Commission’s plan to be implemented faithfully and now works to make sure the NDIS is “the best that it can be”, has just released results from a large satisfaction survey.

NDIS participants and people expecting to join them in the scheme made up 66% of the 21,000 respondents, and a further 23% work in the disability support sector.

The results are mixed. Just 64% of participants said their lives were the same or better than before they went on to the NDIS, and 61% of parents and carers. Slightly more — about three quarters averaged across the two groups — say they get the same amount of support or more than before. The campaign organisation comments:

“While this is a step in the right direction, around a quarter of people said they were worse off. This is a significant issue.”

The survey revealed a “large majority of people in both groups” agreed their planner was responsive to their needs but most also want more information about the process. More worryingly:

“Only around half of people and their families in the NDIS agreed to feeling as though they had choice and control in the process. This is a major red flag.”

A group including Prof Dickinson will publish results from a smaller qualitative research project on May 24, which also shows mixed views among 26 people with disabilities and 16 carers using the scheme in Barwon, Victoria.

The aim is to see how well the experiences of this small cross-section of NDIS participants match up with the promises of more choice and control, equity of access to services and support, and a system that is less complex and more efficient. Broadly, they found:

  • Gratitude for increased funding to access services and resources and reduced waiting lists for services.
  • Frustration about inconsistent access to services, information and resources to be able to exercise choice and control over their care.
  • Disappointment that their knowledge, experience, needs and preferences are being overlooked in planning processes and in the design of the scheme.
  • Concern that boundaries between services they want to combine remain pronounced.
  • Doubt about the capacity of the scheme’s workforce, systems and budget to meet their needs.
  • Suggestions to simplify administrative systems, promote consistency in decision-making when allocating resources, and clarify the aims and objectives of the scheme.

On time. On budget. As promised?

Expectations are key to the success of the NDIS. An enthusiastic group of stakeholders broadly saw everything they wanted to see in the original PC report, perhaps more than it truly offered.

“We’ve deviated a long way now from the Productivity Commission report, so even if that was your benchmark for what the NDIS should be, we’re drifting further and further away from that,” said one academic observer, pointing to the significant reduction in the size and role of the NDIA compared with the blueprint, and the accelerated rollout that was brought forward by one year.

It was proposed to have about 13,000 staff and play a major role in empowering people with disability, which relied in turn on the local care planning and co-ordination roles that have mainly been outsourced in the rush to sign people up over the phone.

The NDIA workforce is now estimated to average out at 2460 full-time equivalents for the coming financial year, up from 1849 across 2016-17.

Local co-ordinators for disability support have been a feature of the WA system since the late 1980s and the retention of these clearly defined roles is one aspect where its version of the NDIS deviates from the rest of the nation.

In stark contrast to the howls of opposition to WA’s exceptionalism, The Mandarin has heard a very different view from several academic NDIS spectators: in this regard, the state has secured something more like the original vision of the NDIS and its participants are likely to get far more consistency in the quality of planning, at the very least.

One former NDIA staff member told The Mandarin a “big cultural change” had occurred in the agency soon after critical media reports began to suggest the rollout was falling way behind its ambitious schedule.

Early on, we’re told, “developing high quality plans for people and helping people achieve their goals” were considered fundamentally important outcomes within the NDIA, but have become eclipsed by the need to push the pace. Several of its external stakeholders also said they noticed the NDIA had come to put being on time and on budget far ahead of any other qualitative outcomes.

The PC inquiry famously concluded the nation’s patchwork of disability systems was “underfunded, unfair, fragmented, and inefficient, and gives people with a disability little choice and no certainty of access to appropriate supports” when it recommended the shift to a nationally consistent, insurance-based approach.

Its plan to get there and the administrators trying to make it happen were always going to be subject to pressure from wider political considerations, to maintain public support for the reform, but these must not be allowed to overshadow the fundamental purpose of the whole exercise and leave it only a stone’s throw from where it started.

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